• Uganda signed a bilateral agreement for as much as $1.7 billion in U.S. health funding

• The plan requires Kampala to increase domestic health spending by more than $500 million

• Uganda becomes the third African country to join the framework after Kenya and Rwanda

Uganda signed a bilateral agreement on Wednesday, December 10, securing up to $1.7 billion in U.S. financing over the next five years to support its health programs. The funding covers HIV/AIDS, tuberculosis, malaria, polio, and maternal and child health.

The protocol also includes support for strengthening human resources and epidemiological surveillance systems. The overall arrangement totals $2.3 billion and forms part of the “America First Global Health Strategy,” which redefines U.S. health assistance and encourages low- and middle-income countries to increase their domestic financing.

In return, Kampala commits to raising national health spending by more than $500 million over the period to gradually assume a greater share of the programs currently funded by the United States.

This agreement makes Uganda the third African country to join the new bilateral structure, after Kenya and Rwanda. Kenya, which signed the deal last week, has seen its implementation suspended by the High Court. The ruling blocks any action involving the transfer, sharing, or dissemination of medical, epidemiological, or sensitive personal data until a full hearing is held to verify protections for Kenyans and their inclusion in the budget.

Under the new framework, Washington favors a direct relationship with governments amid cuts to the U.S. foreign aid budget and the closure of USAID operations in several countries. The State Department presents the approach as a refocus on essential health priorities and an effort to avoid the proliferation of parallel systems, while promoting the acquisition of goods and technologies from U.S. companies.

For Uganda, the challenge is to convert the influx of resources into a lasting strengthening of national capacity: stable program financing, integration of staff previously funded by external arrangements, consolidation of supply chains, and better preparedness for epidemic outbreaks. Kampala emphasizes that the framework must support institutions and reinforce workforce capacity at a time when needs remain high and fiscal space is limited.

For Washington, the credibility of the initiative depends on showing that a bilateral shift can both serve U.S. health security goals and contribute to the resilience of partner systems.

Olivier de Souza